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CUSTOMER INFORMATION

NAME TITLE COMPANY PHONE NUMBER FAX NUMBER MOBILE E-MAIL

ADDRESS
STATE ZIP CODE

TYPE OF POLE

MONOPOLE FLAGPOLE MONOPINE

MONOPALM (CANARY ISLAND) MONOPALM (MEXICAN FAN)

LOCATION

COUNTY
SITE NAME SITE NUMBER

HEIGHT WIND SPEED

SIMULTANEOUS ICE YES NO
FAA LIGHTING YES NO

TYPE OF FINISH: GALVANIZED WEATHERING PAINT OVER GALVANIZED

ANTENNA LOADING

CARRIER 1:
QUANTITY TYPE OF ANTENNA
HEIGHT TYPE OF MOUNT
CARRIER 2:
QUANTITY TYPE OF ANTENNA
HEIGHT TYPE OF MOUNT
CARRIER 3:
QUANTITY TYPE OF ANTENNA
HEIGHT TYPE OF MOUNT
CARRIER 4:
QUANTITY TYPE OF ANTENNA
HEIGHT TYPE OF MOUNT
CARRIER 5:
QUANTITY TYPE OF ANTENNA
HEIGHT TYPE OF MOUNT
CARRIER 6:
QUANTITY TYPE OF ANTENNA
HEIGHT TYPE OF MOUNT
CARRIER 7:
QUANTITY TYPE OF ANTENNA
HEIGHT TYPE OF MOUNT
CARRIER 8:
QUANTITY TYPE OF ANTENNA
HEIGHT TYPE OF MOUNT

MICROWAVE LOADING

LEVEL 1:
QUANTITY OPERATING FREQUENCY
HEIGHT TYPE
LEVEL 2:
QUANTITY OPERATING FREQUENCY
HEIGHT TYPE
LEVEL 3:
QUANTITY OPERATING FREQUENCY
HEIGHT TYPE

ADDITIONAL INFORMATION:

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